Structural and Regional Characteristics and Cost Efficiencies in the Local Public Health Insurance System: Empirical Evidence from the Japanese National Health Insurance System

In this study, I use panel data from municipal Japanese National Health Insurance (JNHI) insurers to estimate their financial efficiency scores using nonparametric methods and to estimate the causal effects of structural and regional characteristics on the efficiency scores consistently using econometric methods. The major findings of this study are as follows. First, the estimated efficiency scores imply that many JNHI insurers have serious financial inefficiencies, and that total cost efficiency (economic efficiency) is strongly and positively correlated with allocative efficiency. Second, the empirical results of the effects of various factors on efficiency scores indicate that the two major policy reforms for health care systems for the elderly in 2008 contribute strongly to the improvement of JNHI insurers’ finances. Third, the subsidy from a prefectural government positively affects efficiencies, but subsidies from central and municipal governments have an adverse effect. Fourth, contributions to health care systems for the elderly still have an adverse effect on JNHI finances

Public and social environment changes and caesarean section delivery choice in Japan

Abstract Objective As in many other countries, the ratio of caesarean section (c-section) delivery to total births in Japan is rising steadily, while the total number of deliveries is decreasing. Although c-sections can effectively prevent maternal and perinatal mortality and morbidity when medically justified, it is uncertain how medically unnecessary c-sections affect the short-, middle-, and long-term postnatal effects on the mother and child. As there are no empirical studies on c-section choice for Japan, this study uses individual medical facility panel data from 1999 to 2014 to comprehensively examine the effects of recent public and social environment changes on c-section delivery choice. Results The empirical results from our fixed effect model show that c-section delivery and its ratio are higher in public hospitals, in relatively large clinics, and in clinics opening on holidays. In addition, increases in the lump-sum birth allowance and the number of medical malpractice lawsuits also increase the number of c-section delivery

The medical assistance system and inpatient health care provision: Empirical evidence from short-term hospitalizations in Japan.

This paper uses two nationally representative sets of medical claims data from medical assistance and universal public health insurance systems to examine how medical assistance system assignment affects short-term inpatient health care provision. In Japan, the medical assistance system, which is part of a public assistance system, provides medical care services for its beneficiaries without imposing any financial burdens, such as copayments or advance premium payments. These circumstances can lead to inpatient costs, as physicians may provide more treatments because there is a financial incentive. Because the assignment of public assistance in Japan is not random but is subject to means testing by the local government, I employ the instrumental variable model to control the potential correlation. I find that medical expenditure is significantly higher for medical assistance patients than for universal public health insurance patients, with an arc elasticity of approximately 0.20. This elasticity is slightly greater than that found for inpatient care in the randomized RAND Health Insurance Experiment and recent empirical studies on low-income populations. In addition, the elasticities for patients who receive medication, treatment and surgery are greater

The effect of habitual smoking on labour productivity

This article investigates the effect of habitual smoking on full-time employees' hourly wages, which represent one of the social costs of smoking. Because the decision whether to smoke is affected by the cigarette tax level and by various socioeconomic factors, it is appropriate that we treat smoking indicators as endogenous in econometric analyses. To control this endogeneity, I use the levels of state and federal cigarette taxes per package and family attributes as instrumental variables for habitual smoking. According to the estimation results, there is no difference in wages between smokers and nonsmokers of both genders after appropriately controlling for the endogeneity of smoking. This result is different from the results of most previous studies, most of which suffer from several methodological problems. I also found that cigarette taxes have a strong impact on smoking participation for both genders. However, it is also found that cigarette taxes do not make smokers without rationality quit smoking.

MEDICAL FEE REFORMS, CHANGES IN MEDICAL SUPPLY DENSITIES, AND SUPPLIER-INDUCED DEMAND: EMPIRICAL EVIDENCE FROM JAPAN

This study empirically investigates whether several negative income shocks to medical suppliers lead them to provide patients with unnecessary and/or excessive treatments. We use a variable that is objectively assessed as representing inducement: the amount of fraudulent and/or incorrect claims detected during the bill inspection processes. The empirical results indicate that medical suppliers increase inducement by 7.5 percent in response to a 1 percent medical fee reduction, but that changes in medical supply densities do not affect it. We also find that medical suppliers in more competitive areas are more sensitive to medical fee reductions and that suppliers in low-density areas tend to provide inducements in response to patient shortages

Electron microscopic study on amyloid fibril formation in human lymph nodes

The purpose of this investigation was to clarify the mechanisms of amyloid fibril formation in human lymph nodes. In our present study, amyloid deposition was observed diffusely in all compartments of the lymph nodes. The deposition form showed extremely characteristic findings in its morphological features. Namely, amyloid deposits mainly consisted of clusters of round or oval nodules. Each amyloid nodule was frequently enclosed with long-stretched cytoplasmic processes of abutting reticulum cells and/or macrophages. Amyloid fibrils often formed parallel amyloid bundles radiating to outlying sections of the nodule from the center. The amyloid bundles closely adhered to the cytoplasmic membrane of not only the abutting reticulum cells, macrophages and sinus endothelium but also to the lymphocytes and plasma cells. In the central portion of the amyloid nodules, a concentric core was also observed. The most interesting finding was the intracellular formation of amyloid fibrils in all cells, such as macrophages, reticulum cells, foreign body giant cells and lymphocytes in the process of degeneration. Some fibrils localized in the limited area of the cytoplasm and others appeared in all parts of the cells, including the nucleus. Their cell membranes were missing in several areas and the cell organella had gradually dissolved. Finally the cell residuums were completely replaced by amyloid fibrils and transformed into a nodular structure with radiating bundles of amyloid fibrils